Dr. Hank Gardner's presentation from the Stanford Medicine X (MedX) Conference 2014. The presentation focuses on population health's connect to patient-centric care, the 5% problem (5% of an employee population driving over 50% of benefit costs), the prevalence of comorbid health conditions, telehealth, and a predictive and comprehensive risk index--Human Capital Risk Index (HUI)--which allows providers and patients to better understand the whole person that is being treated.

1. TELEHEALTH
APPLICATION OF
PREDICTIVE
ANALYTICS
TO DRIVE PATIENT-CENTRIC
CARE:
A Solution for the 5%
Problem
Dr. Harold (Hank) Gardner
HCMS Group CEO

2. The 5% Problem
Population That Drives Over 50% of Health Benefit Costs
• Risky overutilization of medications, testing, and specialists
• Poor access & utilization of primary medical care & prevention
• Significant utilization of lost time and workers’ compensation benefits
• Typically at out-of-pocket maximum, so utilization is free
• Higher utilization with family members
• Over 20% migration into and out of the 5% each quarter
5% of people driving
56% of costs
$
People
#5PercentProblem

3. Human Capital Risk Index® (HUI) – Patent Pending
Unique HUI Features:
• Econometric
(Versus Actuarial)
• Predictive Index (Versus
Lagging)
• Person-Centric (Versus
Disease-Centric)
• Comprehensive – Medical,
Pharmacy, and Lost Time
• Uses More Than 300
Weighted Risk Variables
#HUIRisk

4. 5% Person: Individual Health HUI Risk Profile
VARIABLE WEIGHT
Lung Cancer 4.50
Asthma 0.15
Respiratory Agent 0.05
Anti-Infectives 0.05
Short-Term Disability 1.35
Workers’
2.25
Compensation
Total HUI Score 8.35
#HUIRisk

5. Population Health Risk Analysis: Cost and HUI
0.5
Average HUI = 1.3
1.4
2.8
5.2
6.0
5.0
4.0
3.0
2.0
1.0
0.0
1,200
1,000
800
600
400
200
0
50% 30% 15% 5%
Average HUI Score
Population
Percent of Population
$465
5% of people drive
over 50% of costs
Average Cost = $5,987
$2,987
$11,927
$61,751
$70,000
$60,000
$50,000
$40,000
$30,000
$20,000
$10,000
$0
1,200
1,000
800
600
400
200
0
50% 30% 15% 5%
Average Medical Cost
Population
Percent of Population
HUI risk is
predictive of cost
= Population = Population
= Cost = HUI
#PopulationHealth #HUIRisk

6. 5% Population: Annual Health Benefits Utilization Analysis
Bottom 95% Top 5%
Medications 3 10
Providers 4 11
Diagnoses 4 13
Tests 7 33
Average Individual Integrated Cost $2,383 $40,729
Human Capital Risk Index® (HUI) 0.86 4.06
Health Risk Assessment (HRA)
Self-Report Risk Score
90.3 89.5
#5PercentProblem #HUIRisk

7. 5% Population: Disease Cluster Comorbidity Analysis
#Comorbidities #HUIRisk

8. HUI Telehealth Clinical Decision Support Model
Secure Internal Network
Benefits Sponsor
Clinical
Service
Documentation
Patient-Centered Care
Electronic
Health
Record
Clinical Decision
Support Provider
Data
• HR
• Compensation
• Medical
• Pharmacy
• Lost Time/STD
• Workers’ Comp
On-Demand
Clinical Decision
Support iHUI
#HUIRisk
HIPAA-Compliant
Data
Warehouse
&
Predictive
Analytic HUI

9. Telehealth 5% Solution Results
Right services to the right person at the right time
Waste
Specialty Care &
Prescription
Drug Cost
Person-Centric
Primary Care &
Prevention
Health As
Human Capital
Cost Savings &
Resource for
Worker Wages
#HUIRisk

10. Learn More About HUI & The 5% Problem
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